A Strong Dose of Reality

Although little is new here, Jauhar writes well, and aspects of his saga are interesting. He was not a traditional "straight arrow" who shot directly from college into medical school; he opted for graduate study in physics first. Stories about Jauhar's parents and his courting of a medical student who shared his Indian heritage are deftly woven into his narrative.

Perhaps the most revealing interaction in the book is between Jauhar and his older brother, Rajiv, an interventional cardiologist. If Jauhar is the soul-searching humanist, his brother is a bit of a cowboy, more interested in saving lives than contemplating them. In one intense scene, when Jauhar pages his brother for emergency help, Rajiv curses him out for overreacting, even as Rajiv attends to the patient. Now that is something I have never seen!

Jauhar also writes quite frankly and critically about several former colleagues. One intern is "a young punk with pointy eyebrows," while an "overbearing, arrogant" attending cardiologist is quoted as calling a patient a "scumbag."

Although "Intern" is billed as a chronicle of Jauhar's internship, it actually begins in medical school and ends with the author interviewing for a fellowship in cardiology, the specialty he eventually chose. In the course of this mini-autobiography, Jauhar discusses a series of ethical dilemmas: Is lying to patients ever permissible? Should doctors override the wishes of patients who appear to be making bad choices? Is informed consent as practiced in hospitals essentially meaningless?

But the extended time frame also raises another issue. Jauhar completed his internship a decade ago. In the meantime, many changes have occurred in the training of doctors, most notably limitations on the number of consecutive and total hours that interns may work. For the first time, some interns now complain about being sent home, not about being forced to stay at work.

This situation brings new questions. After years of expecting interns essentially to live in the hospital, what does it mean to train young physicians using a model that is closer to shift work? Will such doctors be as competent as their predecessors? Like other memoirists before him, Jauhar ultimately concludes that his internship, while harrowing, was the best way to learn medicine. "Internship is a classic apprenticeship of immersion," he writes.

Even if the old-fashioned model of internship is becoming obsolete, some of Jauhar's stories are timeless. In one case, after a man died from heart failure and seizures, the staff was unwilling or unable to express appropriate regret to the new widow. Jauhar admits that he, too, was guilty: "I wanted to stay, commiserate, maybe even grieve . . . but I was on call again that night."

You simply cannot remind the medical profession enough that it needs to do a better job in such circumstances.